Nokea
A nurse is preparing a presentation for a local community group about diabetes. Which of the following would the nurse include when describing type 1 diabetes?
- A. Insidious onset
- B. Occurs before age 20
- C. Insulin supplementation required for survival
- D. Formally known as non-insulin-dependent diabetes mellitus
- E. Obesity a risk factor
Correct Answer: B,C
Rationale: Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder; therefore, obesity is not a risk factor.
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A client who is receiving metformin develops lactic acidosis. When planning the care for this client, which nursing diagnosis would the nurse most likely identify?
- A. Ineffective Breathing Pattern
- B. Risk for Fluid Volume Deficit
- C. Acute Confusion
- D. Anxiety
Correct Answer: A
Rationale: When taking metformin, the patient is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which of the following would the nurse most likely give?
- A. Orange or other fruit juice
- B. Glucose tablets
- C. Insulin glargine (Lantus)
- D. Hard candy
- E. Insulin detemir (Levemir)
Correct Answer: A,B,D
Rationale: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.
A client at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. After administration, the nurse would assess the client for which adverse reaction?
- A. Myalgia
- B. Tachycardia
- C. Flatulence
- D. Epigastric discomfort
Correct Answer: B
Rationale: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs.
A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs?
- A. Increased risk of lactic acidosis
- B. Risk of acute renal failure
- C. Increased risk for bleeding
- D. Increased hypoglycemic effect
Correct Answer: D
Rationale: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, meth Methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this client?
- A. Assess the skin for ulcers, cuts, and sores.
- B. Observe the client for hypoglycemic episodes.
- C. Monitor the client for lipodystrophy.
- D. Document family medical history.
Correct Answer: B
Rationale: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.